Blepharoplasty Eyelid Surgery

Blepharoplasty, also known as eyelift and eyelid surgery, has gone through a significant transformation over the past five years. Traditionally, blepharoplasty surgery involves the removal of significant fat, skin and muscle in order to obtain what is perceived as “youthful” eyes. This approach can result in hollowness of the eye area and a “cat-like” look of the corner of the eyes that looks unnatural and changes the entire appearance of the person. Also, complications were more common with these types of procedures.

Today we know that the aging changes around the eyes does not just involve sagging skin. It has multiple components such as loss of skin elasticity, drooping of the eyebrows and cheek fat pads and weakness of supporting eyelid structures that lead to puffiness under the eyes. In the evaluation of aging eyes the forehead and mid face also need to be thoroughly evaluated.

Upper Eyelid Blepharoplasty / Upper Lid BlepharoplastyThe upper eyelid blepharoplasty removes excessive skin, muscle folds and fatty bags that are usually found in the inside corner of the eye. Incisions are made following natural lines and creases. If the eyelid skin is excessive it may obstruct vision leading to a peripheral field defect. This becomes a medical rather than a cosmetic indication for performing an upper blepharoplasty. In such cases, particularly in men with heavy eyebrows pushing the eyelid skin down, a forehead or brow lift is performed in conjunction with an upper blepharoplasty. If necessary, the incisions will extend into the fine squint lines, or crow’s feet, at the outer edges of the eyes. Careful plastic surgical closure uses extremely fine stitches which are removed within three to four days. Once healed, the hairline scars will fade, leaving a very inconspicuous incision line that becomes virtually unnoticeable after a short time.

Lower Eyelid Blepharoplasty / Lower Eye Blepharoplasty Puffiness of the lower eyelids can be caused by an accumulation of fluid within the skin, but it is most often caused by excessive fatty deposits. These fatty deposits can be made worse either from allergies or from fluid retention making them appear worse in the morning. Dark circles under the eyes can be caused by dyscrhromias or pigmentations in the skin, as well as by shadows cast by fatty deposits or the shape of the orbital bone surrounding the eyes.

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Overall, men need a more conservative approach than women do in regards to a blepharoplasty. For example, the classic handsome male brow is full, low and thick, while a female brow can vary from full to thin to low to gentle arched. The eyecrease also varies from female to male (females are much higher than males), and this subtle difference can make the results of a men’s blepharoplasty appear much more natural. Lastly, it is always important for every surgical result to be natural looking as no one wants it to look like they have had surgery, but for men this is even MORE important. Therefore, Dr Azizzadeh and Dr. Cabin always perform a male blepharoplasty with the most natural look possible as the end goal.

Revision Blepharoplasty

Sometimes eyelid surgery does not have the desired outcome. Our team of expert surgeons see many patients who are unhappy with the results of eye surgery and require corrective cosmetic as well as functional surgery. Correction (revision) surgery can be complex of nature. Tissue around the eyes and lids is extremely sensitive and several issues can become a problem if not addressed correctly.

Patients may complain of being unable to close the eye(s) completely. If too much skin was removed during the initial surgery, the surgeon may opt for harvesting tissue from the mouth to elevate the tissue on the inside of the eyelid. Or the Doctor may decide to use skin from behind the ear; which closely resembles eyelid skin.

In many occasions, eyelid surgery not done well can be spotted quickly by the rounded shape of the eye corners versus the natural shape. In many cases the shape of the eyes is also not symmetric. This particular problem can cause irritation when blinking and patients complain of dry eyes often beside the obvious cosmetic issues.

Asian Blepharoplasty Double Eyelid Surgery
An Asian Blepharoplasty eyelid surgery consists of surgically creating a crease in the eyelid in order to establish the double eyelid fold that is a sought after feature in Asian cultures. This a pretty simple procedure that consists of either suturing the eyelid or making a small incision in the natural crease to excise a small amount of fat and muscle to create this favorable characteristic. Read more about Asian Blepharoplasty here.

Non-Surgical Eyelift

As the art and science of eyelid lift rejuvenation has advanced, there has been a significant improvement in the non-surgical solutions for improving the appearance of the eyes. Over the past decade we have learned that volume loss in and around the eyes contribute a significant amount to the aging process of the area. As a result, Dr. Azizzadeh and Dr. Cabin utilize non-surgical volume restoration to address these changes in appropriate candidates. The main advance in this area is the use of in-office injectables to improve the hollowness of the lower eyes and the laxity of the upper eyelids.

The three products that are commonly employed by our expert physicians in eyelid lift procedures are Restylane, Juvederm and fat. Restylane and Juvederm are hyaluronic products (proteins that are naturally found in the skin). Restylane or Juvederm are generally injected in the tear-trough (hollows) region of the lower eyes and can also be used to reduce the laxity of the upper eyelids by improving the position of the eyebrows. Restylane and Juvederm generally have few side-effects and can last up to 8 months. Botox or Dysport injections can also be used to reduce the crow’s feet wrinkles in an Eyelid lift procedure further enhancing the overall appearance. Fat transfer (fat grafting FAMI) can achieve similar results as Restylane and Juvederm. The main difference however is that fat can be a permanent solution for about 90% of individuals. Fat is usually harvested from the abdominal region under local anesthesia and injected in the appropriate regions of the eyes, midface and brows for an eyelid lift. For individuals with significant hollowness and sagging, fat provides a better solution than hyaluronic products.

Another form of non-surgical eyelift is temple rejuvenation, a new technique to regain youthfulness around the eyes. In your 30-s and 40-s it is well known that eyebrows droop and eyes often look tired or angry; however we are now recognizing that the temple region just in front of the hair line starts to hollow as well. This hollowness creates an imbalance in facial proportions leading to an aged look. With the use of Sculptra, a collagen stimulator, Dr. Azizzadeh and Dr. Cabin can fill in the hollowness in the temple region and gently lifts the brow which reverses the aging process and restores the youthful appearance. This technique creates a natural look, correcting the atrophy of the temple and reversing the drooping of the eyebrows elevating them to the original position again. This makes a dramatic improvement to the overall face, bringing forth a more youthful and refreshed appearance. Sculptra injections in the temples are a quick procedure (less than 10 minutes), have minimal bruising, no recovery time. We suggest 2 treatments 6 weeks apart.

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Dr. Azizzadeh is a published expert on Periorbital Fat Grafting.

Before considering blepharoplasty or any eye surgery make sure that you have chosen a qualified blepharoplasty surgeon to take care of your needs and all of your questions. To learn more about blepharoplasty, revision blepharoplasty, non-surgical eyelift or the cost of blepharoplasty and whether or not it is the right procedure for you contact Dr. Babak Azizzadeh and Dr. Jonathan Cabin, facial plastic surgeons located in Beverly Hills, California, to schedule your initial consultation today. Dr. Azizzadeh is the author of several facial plastic surgery books profiling blepharoplasty procedures and other facial rejuvenation techniques.

The CENTER for Advanced Facial Plastic Surgery's site provides information about facial plastic surgery procedures and is not to be taken as medical advice. As a destination for patients from around the world, the CENTER is located in the Los Angeles & Beverly Hills, California area.

The information available on this web site is provided for informational purposes only.This information is not intended to replace a medical consultation where a physician's judgment may advise you about specific disorders, conditions and or treatment options. We hope the information will be useful for you to become more educated about your health care and plastic surgery decisions.